OBJECTIVES: To identify the optimal pharmacological method of preparing patients for nasal endoscopy. METHODS: Twenty healthy volunteers were enrolled in this prospective, randomized, double-blind study. Four types of medications were applied in their nostrils with binary combinations of spray bottles on four different days in a random order: placebo (normal saline [NS]+NS), decongestant (NS+oxymetazoline), anesthetic (NS+lidocaine), and decongestant plus anesthetic (oxymetazoline+lidocaine). Rigid nasal endoscopy was performed 10 minutes after spray application. The volunteers evaluated the discomfort caused by each spray application, and nasal pain scores due to the passage of the endoscope. The physicians quantified nasal decongestion using a visual analogue scale. Endoscopy duration as well as pulse and mean blood pressure (MBP) before spray application, 10 minutes after the application, and immediately after endoscopic examination were also recorded. RESULTS: The discomfort caused by lidocaine was significantly higher than that caused by the other sprays (P<0.001). The lowest pain score related to endoscopy was obtained for oxymetazoline+lidocaine (P<0.001). Nasal decongestion was best achieved with NS+oxymetazoline (P<0.001). Endoscopy duration was the shortest for oxymetazoline+ lidocaine (P<0.05). Statistically significant MBP changes were only seen with the application of NS+oxymetazoline (P<0.05). However, neither MBP nor pulse rate change was significant clinically. CONCLUSION: Application of decongestant and anesthetic sprays together seems to be the best method of pharmacological preparation of patients for nasal endoscopy.
Anesthetics ; Blood Pressure ; Double-Blind Method* ; Endoscopes ; Endoscopy* ; Healthy Volunteers ; Heart Rate ; Humans ; Lidocaine ; Methods* ; Nasal Decongestants ; Oxymetazoline ; Premedication* ; Prospective Studies* ; Volunteers

Vasoconstrictive properties of sympathomimetic drugs are the basis of their widespread use as decongestants and possible source of adverse responses. Insufficiently substantiated practice of combining decongestants in some marketed preparations, such are those containing phenylephrine and lerimazoline, may affect the overall contractile activity, and thus their therapeutic utility. This study aimed to examine the interaction between lerimazoline and phenylephrine in isolated rat aortic rings, and also to assess the substrate of the obtained lerimazoline-induced attenuation of phenylephrine contraction. Namely, while lower concentrations of lerimazoline (10⁻⁶ M and especially 10⁻⁷ M) expectedly tended to potentiate the phenylephrine-induced contractions, lerimazoline in higher concentrations (10⁻⁴ M and above) unexpectedly and profoundly depleted the phenylephrine concentration-response curve. Suppression of NO with NO synthase (NOS) inhibitor N(w)-nitro-L-arginine methyl ester (L-NAME; 10⁻⁴ M) or NO scavanger OHB₁₂ (10⁻³ M), as well as non-specific inhibition of K⁺-channels with tetraethylammonium (TEA; 10⁻³ M), have reversed lerimazoline-induced relaxation of phenylephrine contractions, while cyclooxygenase inhibitor indomethacin (10⁻⁵ M) did not affect the interaction between two vasoconstrictors. At the receptor level, non-selective 5-HT receptor antagonist methiothepin reversed the attenuating effect of lerimazoline on phenylephrine contraction when applied at 3×10⁻⁷ and 10⁻⁶ M, but not at the highest concentration (10⁻⁴ M). Neither the 5-HT1D-receptor selective antagonist BRL 15572 (10⁻⁶ M) nor 5-HT₇ receptor selective antagonist SB 269970 (10⁻⁶ M) affected the lerimazoline-induced attenuation of phenylephrine activity. The mechanism of lerimazoline-induced suppression of phenylephrine contractions may involve potentiation of activity of NO and K⁺-channels and activation of some methiothepin-sensitive receptors, possibly of the 5-HT(2B) subtype.
Animals ; Aorta* ; Indomethacin ; Methiothepin ; Nasal Decongestants ; Nitric Oxide Synthase ; Phenylephrine* ; Prostaglandin-Endoperoxide Synthases ; Rats* ; Relaxation ; Serotonin ; Sympathomimetics ; Tetraethylammonium ; Vasoconstrictor Agents

OBJECTIVES: The maxillary sinus mucosa is reported to recover to preoperative sterility after sinus floor elevation. However, when drainage of maxillary sinus is impaired, recovery can be delayed and maxillary sinusitis can occur. Therefore, in this study, we investigated the correlations between anatomic variants that can interrupt the ostium of the maxillary sinus and incidence of complication after sinus lifting. MATERIALS AND METHODS: The subjects are 81 patients who underwent sinus lifting in Wonkwang University Dental Hospital (Iksan, Korea). Computed tomography (CT) images of the subjects were reviewed for presence of nasal septum deviation, anatomic variants of the middle turbinate, and Haller cells. Correlations between anatomic variations and occurrence of maxillary sinusitis were statistically analyzed. RESULTS: Patients with anatomic variants of ostio-meatal units, such as deviated nasal septum, concha bullosa or paradoxical curvature of the middle turbinate, or Haller cells, showed a higher rate of complication. However, only presence of Haller cell showed statistically significant. CONCLUSION: Before sinus lifting, CT images are recommended to detect anatomic variants of the ostio-meatal complex. If disadvantageous anatomic variants are detected, the use of nasal decongestants should be considered to reduce the risk of postoperative sinusitis.
Anatomic Variation ; Drainage ; Humans ; Incidence ; Infertility ; Lifting* ; Maxillary Sinus* ; Maxillary Sinusitis ; Mucous Membrane ; Nasal Decongestants ; Nasal Septum ; Postoperative Complications* ; Sinus Floor Augmentation ; Sinusitis ; Turbinates

The common cold is an acute, self-limiting viral infection of the upper respiratory tract involving the nose, sinuses, pharynx and larynx. Drug therapies for the common cold are normally aimed at relieving the symptoms of the illness. Over-the-counter cough and cold medications should not be used in children younger than four years old because of potential harms and lack of benefit. Antibiotics, antitussives, anti-histamines, and inhaled corticosteroids are not effective in children. Products that may improve symptoms in children include expectorants, mucolytics, honey, vitamin C, zinc lozenges, geranium extract, and nasal saline irrigation. In adults, antihistamines, intranasal corticosteroids, codeine, intranasal ipratopium, and antibiotics are not effective. Decongestants, antihistamine/decongestant combi-nations, expectorants, and mucolytics may improve cold symptoms in adults. Nonsteroidal anti-inflammatory drugs and acetaminophen reduce pain secondary to upper respiratory tract infection in adults. Among complementary and alternative medicinetherapeutics, products containing vitamin C, zinc, or garlic may improve cold symptoms in adults. Prophylactic use of probiotics may decrease the frequency of colds in adults and children.
Acetaminophen ; Adrenal Cortex Hormones ; Adult ; Anti-Bacterial Agents ; Anti-Inflammatory Agents, Non-Steroidal ; Antitussive Agents ; Ascorbic Acid ; Child ; Codeine ; Common Cold* ; Complementary Therapies ; Cough ; Drug Therapy* ; Expectorants ; Garlic ; Geranium ; Histamine Antagonists ; Honey ; Humans ; Larynx ; Nasal Decongestants ; Nonprescription Drugs ; Nose ; Pharynx ; Probiotics ; Respiratory System ; Respiratory Tract Infections ; Zinc

Allergic rhinitis (AR) is defined as chronic inflammatory reactions to common allergens in the nasal mucosa with at least two AR symptoms including rhinorrhea, nasal congestion, sneezing, nasal/ocular pruritus, and postnasal drainage. AR is a common health problem, and it affects around 10-25% of general population. Its prevalence is increasing according to the environmental changes. AR and asthma frequently coexist in the same patient, therefore we should consider it and check for asthma to diagnose AR. Antihistamines and nasal corticosteroids are recommended as the 1st line treatment of AR. Decongestants may be effective for nasal congestion, and leukotrienes are helpful to improve both nasal and bronchial inflammations in patients with AR and asthma. Allergen specific immunotherapy is useful in IgE mediated AR and can prevent the progression to asthma and new sensitizations. Appropriate AR treatment including medications and immunotherapy can improve symptoms and reduce medications. Finally improvement of quality of life can be achieved.
Adrenal Cortex Hormones ; Allergens ; Asthma ; Drainage ; Estrogens, Conjugated (USP) ; Histamine Antagonists ; Humans ; Immunoglobulin E ; Immunotherapy ; Inflammation ; Leukotrienes ; Nasal Decongestants ; Nasal Mucosa ; Prevalence ; Pruritus ; Quality of Life ; Rhinitis* ; Rhinitis, Allergic, Perennial ; Sneezing

Allergic rhinitis (AR) is defined as chronic inflammatory reactions to common allergens in the nasal mucosa with at least two AR symptoms including rhinorrhea, nasal congestion, sneezing, nasal/ocular pruritus, and postnasal drainage. AR is a common health problem, and it affects around 10-25% of general population. Its prevalence is increasing according to the environmental changes. AR and asthma frequently coexist in the same patient, therefore we should consider it and check for asthma to diagnose AR. Antihistamines and nasal corticosteroids are recommended as the 1st line treatment of AR. Decongestants may be effective for nasal congestion, and leukotrienes are helpful to improve both nasal and bronchial inflammations in patients with AR and asthma. Allergen specific immunotherapy is useful in IgE mediated AR and can prevent the progression to asthma and new sensitizations. Appropriate AR treatment including medications and immunotherapy can improve symptoms and reduce medications. Finally improvement of quality of life can be achieved.
Adrenal Cortex Hormones ; Allergens ; Asthma ; Drainage ; Estrogens, Conjugated (USP) ; Histamine Antagonists ; Humans ; Immunoglobulin E ; Immunotherapy ; Inflammation ; Leukotrienes ; Nasal Decongestants ; Nasal Mucosa ; Prevalence ; Pruritus ; Quality of Life ; Rhinitis* ; Rhinitis, Allergic, Perennial ; Sneezing

Rhinitis is a global problem and is defined as the presence of at least one of the following: congestion, rhinorrhea, sneezing, nasal itching, and nasal obstruction. The two major classifications are allergic and nonallergic rhinitis (NAR). Allergic rhinitis occurs when an allergen is the trigger for the nasal symptoms. NAR is when obstruction and rhinorrhea occurs in relation to nonallergic, noninfectious triggers such as change in the weather, exposure to caustic odors or cigarette smoke, barometric pressure differences, etc. There is a lack of concomitant allergic disease, determined by negative skin prick test for relevant allergens and/or negative allergen-specific antibody tests. Both are highly prevalent diseases that have a significant economic burden on society and negative impact on patient quality of life. Treatment of allergic rhinitis includes allergen avoidance, antihistamines (oral and intranasal), intranasal corticosteroids, intranasal cromones, leukotriene receptor antagonists, and immunotherapy. Occasional systemic corticosteroids and decongestants (oral and topical) are also used. NAR has 8 major subtypes which includes nonallergic rhinopathy (previously known as vasomotor rhinitis), nonallergic rhinitis with eosinophilia, atrophic rhinitis, senile rhinitis, gustatory rhinitis, drug-induced rhinitis, hormonal-induced rhinitis, and cerebral spinal fluid leak. The mainstay of treatment for NAR are intranasal corticosteroids. Topical antihistamines have also been found to be efficacious. Topical anticholinergics such as ipratropium bromide (0.03%) nasal spray are effective in treating rhinorrhea symptoms. Adjunct therapy includes decongestants and nasal saline. Investigational therapies in the treatment of NAR discussed include capsaicin, silver nitrate, and acupuncture.
Acupuncture ; Adrenal Cortex Hormones ; Allergens ; Capsaicin ; Cholinergic Antagonists ; Eosinophilia ; Estrogens, Conjugated (USP) ; Histamine Antagonists ; Humans ; Immunotherapy ; Ipratropium ; Leukotriene Antagonists ; Nasal Decongestants ; Nasal Obstruction ; Odors ; Pruritus ; Quality of Life ; Rhinitis ; Rhinitis, Allergic, Perennial ; Rhinitis, Atrophic ; Silver Nitrate ; Skin ; Smoke ; Sneezing ; Therapies, Investigational ; Tobacco Products ; Weather

Common cold is a conventional term for a mild upper respiratory illness characterized by symptoms of nasal stuffiness, rhinorrhea, sneezing, sore throat, and cough. Management of the common cold is intended to provide temporary relief of symptoms until the cold completes its natural history, as well as to reduce the risk of complications. However, most studies for cold preparations focus on adults, and there are limited and conflicting evidences for children. Various preparations for cough/cold are available, which include antihistamines, decongestants, antitussives, expectorants, analgesics/antipyretics, and some combination products. Nonpharmacologic therapies are also important and it is generally agreed that such supportive cares should form the mainstay of treatment for children with common colds. Adverse effects of the specific types of cold preparations should be considered carefully for very young children. In addition, it is very important to educate parents about the natural course of common cold, along with appropriate use correct dosages and potential adverse effects of cold preparations.
Adult ; Antitussive Agents ; Child ; Cold Temperature ; Common Cold ; Cough ; Expectorants ; Histamine Antagonists ; Humans ; Infant ; Nasal Decongestants ; Natural History ; Parents ; Pharyngitis ; Sneezing

Despite major advances in medicine, acute upper respiratory infections (URI) continue to be a huge burden on society in terms of human suffering. Acute rhinopharyngitis (common cold), acute sinusitis (viral and bacterial), acute pharyngotonsillitis, acute laryngitis are categorized as this common health problem. Several viruses can cause common cold, but rhinoviruses are by far the most common. Alleviation of symptoms with drugs such as nasal decongestants and acetaminophen, remains as the main way to manage common cold. Patients with acute pharyngotonsillitis should be treated with antibiotics (amoxicillin) for 10 days, but adult patients have low risk for late complications (rheumatic fever and glomerulonephritis) of S. pyogenes infection. Patients with acute viral sinusitis will recover over the course of 7~10 days without antibiotics. Amoxicillin is drug of choice for acute bacterial sinusitis in the practice guidelines. Evidence-based approach is greatly needed for appropriate care for URI patients. Effective antiviral agents and vaccines for URI pathogens should be studied, while the related researches can be challenging. Evidence-based practice for URI and patient education are good medical practice to deal with with these very common health problems.
Acetaminophen ; Adult ; Amoxicillin ; Anti-Bacterial Agents ; Antiviral Agents ; Common Cold ; Evidence-Based Practice ; Fever ; Humans ; Laryngitis ; Nasal Decongestants ; Patient Education as Topic ; Respiratory Tract Infections ; Rhinovirus ; Sinusitis ; Stress, Psychological ; Vaccines

The diagnosis of allergic rhinitis can generally be made on the basis of the history and physical examination. The history helps establish seasonality, potentially inciting factors, and co-morbidities including sinusitis, nasal polyps, allergic conjunctivitis, and asthma. On physical examination, the nasal mucous membranes are pale, wet, and boggy. Allergy testing is performed in order to confirm the diagnosis and which allergens are relevant to the symptoms. The management of allergic rhinitis includes allergen avoidance, pharmacologic treatment, and specific immunotherapy. Mild symptoms are easily controlled with either a second-generation antihistamine or a nasal corticosteroid alone. For patients with moderate-to-severe symptoms with nasal congestion as a predominant finding, therapy should be started with daily use of a nasal corticosteroid, which would be combined with other medications, such as antihistamines and decongestants. Specific immunotherapy is generally reserved for the selected patients whose symptoms are inadequately controlled with a pharmacotherapy and allergen avoidance.
Allergens ; Asthma ; Conjunctivitis, Allergic ; Estrogens, Conjugated (USP) ; Histamine Antagonists ; Humans ; Hypersensitivity ; Immunotherapy ; Mucous Membrane ; Nasal Decongestants ; Nasal Polyps ; Physical Examination ; Rhinitis ; Rhinitis, Allergic, Perennial ; Seasons ; Sinusitis ; Skin Tests